Critical Care Time 71. LIVE! From CHEST 2025: Cases in Cardiogenic Shock
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Mar 9, 2026 Nick Hodgman, a pulmonary and critical care physician from El Paso, joins a live CHEST 2025 panel to dissect challenging cardiogenic shock cases. They walk through invasive hemodynamics, SCAI staging, device choices like Impella and ECMO, and team-based escalation for LV and RV failure. Real-world cases include post-MI VSD management and ARDS with RV collapse.
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Stage Shock Early And Start Norepinephrine
- Use the SCAI shock staging early to guide initial therapy rather than guessing from appearance alone.
- For hypotensive post-MI with lactate and low CI, start norepinephrine, optimize preload/afterload, and call your shock team quickly.
Cardiac Power Output Predicts Left Shock Severity
- Cardiac power output (CPO) is the best single hemodynamic predictor for mortality in left-sided cardiogenic shock.
- CPO = MAP × CO / 451; values <0.8 are concerning and can be trended to assess response to therapy.
Add Inotrope Or Escalate To Device If Lactate Rises
- When a patient on norepinephrine still has low CI and rising lactate, add inotropic support or consider immediate mechanical support rather than switching to dopamine or epinephrine.
- Choose dobutamine or milrinone based on blood pressure and timing, and move to IABP/Impella if rapid deterioration persists.